MRI Urodynamic Evaluation of Early Changes in Diabetic Cystopathy|
Pilot & Feasibility Program
Lower urinary tract dysfunction is common in patients with diabetes. The onset and early progression of bladder dysfunction are generally insidious. Patients typically present after being diabetic for many years with difficulty emptying the bladder. There is a critical need to characterize the early stages in development of diabetic cystopathy in order to develop strategies for early diagnosis and intervention and to facilitate development of effective medical options to prevent progression to end-stage bladder dysfunction. This proposal addresses three important knowledge gaps that are critical to improve prevention and treatment of diabetic cystopathy. The first is that the changes in bladder voiding function that occur early in the development of diabetic cystopathy in humans has never been comprehensively studied. The second is that the effect of diabetes on coordination of the voiding reflex in humans has never been examined. The third is that possible gender differences in development of diabetic cystopathy have not been addressed. We postulate that diabetes-induced dyscoordination of the detrusor contraction and funneling of the bladder neck during voiding occur early in the disease process and are critical factors in development of voiding symptoms and impaired bladder emptying. These changes would not have been identified previously, since multichannel pressure-flow studies lack dynamic 3-dimensional imaging of the bladder and outlet during voiding. We will use a recently developed MRI-based non-invasive dynamic imaging protocol to image the bladder and outlet during voiding in young adult men and women with type 1 diabetes to assess symmetry of the detrusor contraction and coordination with opening of the bladder outlet. We postulate that this will demonstrate asymmetric and uncoordinated contraction of the detrusor as well as asynchronous or incomplete descent of the bladder base and funneling of the bladder neck as compared to age-matched healthy controls. We expect our studies to yield a comprehensive evaluation of early stages of diabetic bladder dysfunction, reveal a heretofore unknown feature of that dysfunction and inform the development and use of interventions to prevent clinical progression.